A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation

Clinical article

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Object

The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods.

Methods

A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software.

Results

There was no significant difference in initial SDH volume (94.5 cm3 vs 112.6 cm3, respectively; p = 0.25) or final SDH volume (31.9 cm3 vs 28.2 cm3, respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood.

Conclusions

The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

Abbreviations used in this paper:SDH = subdural hematoma; SEPS = subdural evacuating port system.

Article Information

Drs. Safain and Roguski contributed equally to this work.

Address correspondence to: Ron Riesenburger, M.D., Department of Neurosurgery, Proger 7, 800 Washington Street, Boston, Massachusetts 02110. email: rriesenburger@tuftsmedicalcenter.org.

Please include this information when citing this paper: published online December 21, 2012; DOI: 10.3171/2012.11.JNS12689.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Subdural evacuating port of the SEPS attached to a Jackson-Pratt bulb via a silicone tube.

  • View in gallery

    Bar graphs depicting comparisons of SEPS versus traditional methods for initial volume, final volume, and percentage change (95% CIs depicted within the bars). There were no statistically significant differences between the SEPS and traditional groups.

  • View in gallery

    Bar graphs depicting resolution of SDH in the traditional methods group (bur hole and craniotomy) with and without placement of a postoperative subdural drain (SDD; 95% CIs depicted within bars). Patients without SDDs had a significantly higher rate of SDH resolution as compared with patients with SDD placement (p = 0.00029).

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